By Christi Springfield, PT, DPT
The single most common surgery in the United States is Cesarean section. They are so common that we might forget that C sections are major abdominal surgeries. During C sections though, the OB GYN cuts through a startling SEVEN layers of tissue to achieve surgical delivery. While we have robust protocols in place for other major abdominal surgery, routine rehab interventions for C-section delivery are notably absent. We already know that the needs of pregnant and postpartum people need to be prioritized and addressed to maximize healing, without delay. When you combine postpartum challenges with recovery from major abdominal surgery, the needs for physical therapy intervention are crystal clear.
Many new moms who undergo C-sections have endured brave attempts at vaginal delivery, sometimes pushing for hours, even after previous grueling hours of active laboring. Unplanned C-sections, or emergency C-sections, perhaps highlight the most critical instances where a new mom can experience all the bodily trauma that can manifest following labor and delivery.
Physical therapists ideally have the opportunity to evaluate and educate and train every pregnant person ideally no later than 3rd trimester, so that she is armed with information and techniques to optimize recovery after vaginal delivery and/or planned C-section. It’s particularly important for new moms to know how to breathe and move, while protecting both their abdominal walls, caring for their incision and optimizing pelvic recovery.
It’s imperative that patients with C-sections receive a level of care equivalent to what is offered for patients who undergo total knee replacements (TKR), for instance. People who have simple joint surgery have pre rehab to get stronger prior to scheduled elective
surgery. Immediately postoperatively, people who are getting TKRs have physical therapy intervention in the hospital and then timely follow up with outpatient therapy following surgery. How can we expect any less for a mom who has just gestated a baby human through her abdominal wall—pushing down onto her pelvic floor for 9 months— especially when, at the end of it, she undergoes major abdominal surgery?! Afterward,
that post op/postpartum mom has to feed, hold and carry a roughly 10-pound infant, managing somehow to desensitize her incision, activate her belly wall muscles without holding her breath, and safely perform all of her activities of daily living without straining her back. New moms need to have exceptional physical therapy intervention to learn how to safely move in bed to avoid excess stress and strain on their abdominal walls and pelvic floors. They need to know how to progressively lie down, flatter and flatter, stretching out the incision and learning how to perform scar massage to move the tissue around so it doesn’t become restricted and tight. Postpartum patients who’ve had C-sections need to know how to safely brace their weakened abdominal walls and pelvic floors, to breathe properly and lift/ carry their infants, positioning them to avoid preventable neck and shoulder straining to new moms during feeding.
Paying careful attention to postpartum moms with C-sections can actually be a matter of life and death. The data is troubling (and sadly, not improving) when we look at outcomes for morbidity and mortality of postpartum people. Surgical complications can be sudden and life-threatening. Postpartum hemorrhage, infections, postpartum preeclampsia, and blood clots can all quickly progress to medical emergencies. This partially explains why postpartum patients following C-sections have the highest risk of death within the first six weeks. Having early outpatient follow up with pelvic physical therapy is ideal for promoting proper belly wall engagement, managing symptoms of urinary leakage, pain, constipation, monitoring vital signs and screening for red flags, including perinatal mood disorders. The key to improving the health and well-being of moms with C-sections is to educate all*women to advocate for themselves and insist upon physical therapy intervention immediately after a C-section and beyond. Let’s make it the standard of care to protect and cherish those who are giving birth to a new generation.